Provider Demographics
NPI:1689873879
Name:JONES, DEREK W (DMD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:W
Last Name:JONES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 GEORGE ST APT 2G
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1031
Mailing Address - Country:US
Mailing Address - Phone:401-636-0320
Mailing Address - Fax:
Practice Address - Street 1:960 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-3310
Practice Address - Country:US
Practice Address - Phone:732-727-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI02353800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist